Medical travel policies lack compassion and need review, says Gwich'in grand chief

Some northern Indigenous leaders are calling for changes to Canada's Non-Insured Health Benefits (NIHB) program particularly when it comes patients who need to travel for care and require a medical escort.

Ken Kyikavichik, grand chief of the Gwich'in Tribal Council in the N.W.T., told a Parliamentary committee on Friday that the current system "lacks compassion" for rural Indigenous patients who have unique needs.

The standing committee for Indigenous and Northern Affairs has been scrutinizing the Non-Insured Health Benefits (NIHB) program, which covers some medicare costs — like dental, vision and out-of-territory medical travel — for those who can prove their status and who don't already get health-care coverage through their place of work. 

Speaking to the committee, Kyikavichik described how the system routinely fails Indigenous northerners because of "confusion and miscommunication between the N.W.T. health care system and NIHB."

He singled out the interpretation of policy around escorts — family or other caregivers who travel with patients as needed support — as a "flash point" for the N.W.T. government and the federal program.

"It is common for us to hear of residents who require a medical travel escort and do not receive one. This is especially concerning when we are dealing with the elderly," Kyikavichik said.

"When medical travel escorts are sought from the N.W.T. Health and Social Services Authority, our people are often caught in the bureaucracy and required to prove their conditions. Otherwise ... this essential support is seemingly automatically denied."

The N.W.T. government "pre-authorizes" who travels with patients according to a list of criteria, including whether they can travel alone and if they are a minor. In some cases, a doctor has to support the patient's request for insurance to cover their caretaker's travel costs.

The policy considers the need for more than one escort an "exceptional circumstance," where the patient would have to provide more private health information to justify their claims.

Kyikavichik is asking for a review into how the N.W.T. government and NIHB works together to provide medical transportation services. 

"The medical travel system in the Northwest Territories appears to lack the compassion that is required for these very sensitive situations that our residents face," he said. 

Kyikavichik described a "two-tier system" that exists in the N.W.T., where territorial government workers — predominantly non-Indigenous — enjoy lavish health benefits compared to most of the territory's non-Indigenous residents.

The territories' health ministers have also told the parliamentary committee that major changes to the NIHB are needed, saying the plan does not cover several unique healthcare needs for Indigenous people including travel costs for patients' family members. Yukon's health minister also said it's not always clear when the territories should be absorbing medical travel costs, and when they are covered by the NIHB program.  

'Many inconsistencies'

The committee also heard on Friday from Maggie Putulik of Nunasi Corporation, an Inuit-owned business that operates Inuit medical accommodation facilities in Ottawa, Winnipeg, Edmonton and Yellowknife. Putulik described the NIHB as an important program for Inuit, though she shared some of Kyikavichik's concerns.

She suggested the need for a clear new policy for the governments of N.W.T. and Nunavut on medical escort eligibility, to avoid "misinterpretation."

"We have experienced many inconsistencies in applying the escort policy, in particular with the [N.W.T. government]," Putulik said.

"The federal government needs to implement a clear policy that specifically outlines who can be eligible to have an escort because the policy, as it is at the moment, is vague and broad, and it could be misinterpreted by, in particular, medical travel personnel within those two levels of government."

Nunavut MP Lori Idlout, who sits on the committee, also suggested that medical escorts should be paid.

"The escorts who are interpreters, assistants and who aid the patient, they leave their full time jobs, often without pay, to take time off to do this service," Idlout said.

"They should be called a 'patient navigator,' under a payroll. Because they are an essential service to the person that they're assisting. It is a very critical job they do, and they should be remunerated as such."